POL M803: TRANSFERRING RESOURCES

1. Resource Transfers Occur When Ownership Is Reduced Or Is Eliminated

A resource transfer occurs when any action is taken that reduces or eliminates an individual’s ownership or control of the resource.

2. Transfer Provisions Do Not Apply To Certain Programs

Transfer provisions do not apply to the following programs:

• • Family and Children’s.

  • Inpatient Hospital Care.

  • Hospice.

  • Tuberculosis.

  • Medicare Savings Programs.

  • Supplemental Security Income (SSI).

3. Certain Types Of Transfers Are Exempt

The following must be considered exempt transfers:

• • Legally enforceable debt settlement.

  • Clearing title to property in which the client had no beneficial or enforceable interest.

  • Equity in property, which was owned jointly, if other owner was granted equity through a court action.

  • Resources sold, traded or transferred at fair market value.

  • Resources transferred to an approved Special Needs, Pooled or Income Trust.

4. Transfers To Certain Individuals Are Exempt

The following transfers must be considered exempt:

• • Home property was transferred to the individuals:

    • Spouse.

    • Child under age 21.

    • Child of any age who is blind or disabled. Verify through one of the following sources:

      • SOLQ;

      • Letter from SSA;

      • Collateral Contact with SSA; or

      • SDX or BDX interfaces

    • Sibling who has equity interest in the home and who resided in the home for at least one year immediately prior to the date of admission to a medical facility or eligibility for the Home and Community Based Services Program. Refer to Table 5B for acceptable verifications to prove the sibling resided in the home for the required time period.

    • Son or daughter resided with the parent for a period of at least two years immediately prior to the date of admission to a medical facility or eligibility for the Home and Community Based Services Program and provided care in the home. Require the following verifications:

      • Refer to Table 5B for acceptable verification to prove the son or daughter resided in the home for the required time period;

      • Affidavit of Caretaker (DHCF 400); and

      • Physician Statement (DHCF 402).

  • Non-Home property was transferred to the individuals:

    • Spouse; or

    • Another person for the sole benefit of the transferor's spouse; or

    • Child of any age who is blind or disabled. Verify through one of the following methods:

      • SOLQ;

      • Letter from SSA;

      • Collateral Contact with SSA; or

      • SDX or BDX interfaces.

5. Clients Must Demonstrate Intention And Evidence To Exempt Resource Transfers

Clients must show they intended to dispose of the resource at fair market value or for another valuable consideration.

Clients must demonstrate the intent of the transfer was not for Medicaid eligibility purposes. Evidence provided must show:

• • The transfer was court ordered (provided the claimant took no action to petition the court to order the transfer).

  • At the time of transfer, the individual could not have anticipated the need to apply for eligibility (e.g., the individual became disabled following a traumatic accident, but was not disabled when the transfer occurred).

  • After the transfer, there was a traumatic onset of disability (e.g., traffic accident or a diagnosis of a previously undetected disabling condition).

  • Total countable resources, including the transferred resource, were below the resource limit at all times from the month of transfer through the present month.

  • Denial of eligibility would result in undue hardship.

6. Nursing Facility Payment Withheld For Nonexempt Resource Transfers

If clients transfer nonexempt resources for less than fair market value, but meet all other eligibility factors, a penalty period must be imposed. During the penalty period:

• • Payment for nursing home facility services must be withheld, and benefits authorized for the Medicaid Services Only Program.

7. HCBS Waiver Eligibility Delayed For Nonexempt Resource Transfers

Process for manually calculating the penalty period and communicating the length to the Community Based Services Unit or the Behavioral Health Division/Developmental Disabilities Section:

• • The penalty period for a Waiver applicant begins from the time both financial eligibility and medical necessity are met. A plan of care is not required to start the penalty period.

  • Contact the Community Based Services Unit or the Behavioral Health Division/Developmental Disabilities Section with the end date of the penalty period to prevent Waiver services from being paid until completion of the penalty.

8. Transferred Resources May Be Returned

Transferred resources causing ineligibility may be returned. When this occurs, no penalty for the transfer is assessed.

Retroactive adjustments must be made for returned resources that initially resulted in a penalty and denied benefits.

Returned resources are counted in the first month following the month of return.